First Do No Harm: Ethical Issues in Pathologizing Normal Variations in Behavior and Functioning

Suhr, Julie A.; Johnson, Ellen

doi:10.1007/s12207-022-09455-z

Cited by 12 publications

(11 citation statements)

References 76 publications

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“…In laypeople's perspective, the ability of experts to reliably distinguish between genuine and feigned ADHD appears to be similarly poor. This is well in line with the description of multiple difficulties in determining genuine ADHD, the large variety of diagnostic approaches used by practitioners in real-world assessment contexts (e.g., Schneider et al, 2019), and calls for a more systematic use of validity tests in clinical ADHD assessments (Suhr & Johnson, 2022).…”

Section: Discussionsupporting

confidence: 71%

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Laypeople's prevalence estimates of malingering: Survey data from the Netherlands.

Merten¹,

Tucha²,

Giger³

et al. 2023

Psychology & Neuroscience

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Objective: Noncredible symptom claims not only occur in a sizable number of forensic cases, but also in clinical contexts. Health providers and forensic experts are confronted with the question of whether individual symptom claims are genuine, grossly exaggerated, or even invented. We investigated laypeoples’ prevalence estimates, their attitude and beliefs about malingering. Method: Extending a survey format from a previous Swiss study, we analyzed responses from 975 adult Dutch nationals who responded to an online structured interview on their assumptions and attitudes about malingering (in Dutch language sense of intentional symptom fabrication with an external goal). Results: Participants estimated that a sizeable minority of cases in different prototypical situations feigned symptoms to achieve external goals. They estimated that malingering most commonly occurs in offenders seeking diminished criminal responsibility. One in every seven participants admitted having malingered themselves, and many were confronted with malingering by family members, work colleagues, friends, or neighbors. Although the majority morally condemned malingering, a sizable minority admitted that malingering might be an option for themselves. Participants generally favored an adaptational and a criminological explanatory model of malingering (35% each). Conclusions: The high prevalence of noncredible symptom claims suspected by laypersons in diverse clinical and legal contexts corresponds to base rate estimates derived from numerous other surveys and group studies. Myths perpetuated by some clinical and forensic workers are seriously challenged by laypersons’ opinion, based on their very personal social perceptions of the reality, and on their admission of having feigned symptoms in the past themselves.

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Section: Discussionsupporting

confidence: 71%

“…This is often the case in patients with factitious disorder, to name the most obvious constellation of potential harm unnecessarily caused to mental health patients. Suhr and Johnson (2022) and Harrison (2022).…”

Section: Discussionmentioning

confidence: 99%

Laypeople's prevalence estimates of malingering: Survey data from the Netherlands.

Merten¹,

Tucha²,

Giger³

et al. 2023

Psychology & Neuroscience

View full text Add to dashboard Cite

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“…Without normative data, it is difficult to determine if students' perceived difficulties reflect substantial limitations in functioning or academic challenges experienced by most postsecondary students. Several studies have shown high rates of self-reported academic problems among students without disabilities (Lewandowski et al, 2008;Suhr and Johnson, 2022). Students without disabilities may report academic problems because they evaluate their performance with respect to an idealized level of functioning or to academically talented peers (Johnson and Suhr, 2021).…”

Section: Norm-referencedmentioning

confidence: 99%

“…Reading long and complex passages, completing highstakes exams, and learning new languages are difficult and often stressful activities. Many students without disabilities report problems with common academic tasks like these (Suhr and Johnson, 2022) and recognize that accommodations might increase academic performance (Lewandowski et al, 2014). Without normative data, disability professionals must make accommodation decisions based on the quality of students' narratives and their subjective impressions.…”

Section: Introductionmentioning

confidence: 99%

Assessing academic impairment in college students with disabilities: A new measure to promote evidence-based accommodation granting

2022

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College students with disabilities may be entitled to academic accommodations such as additional time on exams, testing in a separate setting, or assistance with note-taking. To receive accommodations, students must request services from their college and show that they experience substantial limitations in academic functioning. Without norm-referenced data, it is difficult for college disability support professionals to determine if students’ self-reported academic problems reflect substantial limitations characteristic of a disability, or academic challenges experienced by most other students. The Academic Impairment Measure (AIM) is a brief, multidimensional, norm-referenced rating scale that can help professionals identify college students with significant impairment who need academic support. Exploratory and confirmatory factor analysis indicate that the AIM assesses seven distinct and interpretable domains of academic functioning relevant to postsecondary students. Initial studies also provide evidence of internal and temporal consistency; composite reliability; content, convergent and discriminant validity; and the ability to differentiate students with and without disabilities. Finally, the AIM includes a response validity scale to detect non-credible ratings. Normative data from a large, diverse standardization sample allow professionals to use AIM scores to screen students for significant impairment, tailor accommodations to students’ specific limitations, and monitor the effectiveness of accommodations over time.

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“…Malleson suggested that the steep increase in whiplash cases arose in part because some professionals were able to create an epidemic; they were willing to exploit people's suggestible nature, encouraging people to be assessed for, and then blame all their troubles and difficulties on a useful illness (like whiplash) rather than take personal responsibility for their problems or working to remediate or eliminate the cause of their issues. The article by Suhr and Johnson (2022, in this special issue) addresses these issues directly. They document the marked increase in the number of postsecondary students currently receiving academic accommodations and the growing disparity in the types of students receiving these accommodations.…”

Section: Clinicians In Need Of a Reliable Income Sourcementioning

confidence: 99%

Attention Deficit Hyperactivity Disorder, Learning Disorders, and Other Incentivized Diagnoses — A Special Issue for Psychologists

Harrison

2022

Psychol. Inj. and Law

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Results from psychoeducational and neuropsychological assessments are relied upon frequently to determine disability status or confirm access to disability-related services and supports both in postsecondary education and on high-stakes exams. Sadly, research shows that many clinicians make these diagnoses using flexible diagnostic criteria and a looser conception of disability that includes otherwise normal test scores. Given the tangible academic, economic and social benefits that can be obtained for students given these disabilities, it is no wonder that the rates of non-visible disabilities have skyrocketed in the past 20 years. Research shows that these types of diagnoses have risen mainly in higher-income families, which suggests inequity in how these diagnoses are being made. What is more difficult to understand are the reasons why clinicians are increasingly ignoring or loosening published diagnostic criteria to make such diagnoses, and failing to investigate performance and symptom credibility. This special issue of Psychological Injury and Law offers insights from clinicians regarding why these and other issues are occurring more frequently, outlines the harm that occurs when disability diagnoses become incentivized and encouraged, and makes recommendations for how assessment practices must change. If things remain the same, psychologists risk losing credibility and input into the accommodation decision-making process.

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First Do No Harm: Ethical Issues in Pathologizing Normal Variations in Behavior and Functioning

Cited by 12 publications

References 76 publications

Laypeople's prevalence estimates of malingering: Survey data from the Netherlands.

Laypeople's prevalence estimates of malingering: Survey data from the Netherlands.

Assessing academic impairment in college students with disabilities: A new measure to promote evidence-based accommodation granting

Attention Deficit Hyperactivity Disorder, Learning Disorders, and Other Incentivized Diagnoses — A Special Issue for Psychologists

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